Comprehensive cohort study: computer tomography-guided high-dose rate brachytherapy as metastasis-directed therapy for liver metastases from colorectal cancer in repeat oligoprogression.

IF 9.7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiologia Medica Pub Date : 2025-05-01 Epub Date: 2025-03-13 DOI:10.1007/s11547-025-01988-y

Mateusz Bilski, Katarzyna Korab, Magdalena Orzechowska, Julia Ponikowska, Paweł Cisek, Barbara Alicja Jereczek-Fossa, Jacek Fijuth, Łukasz Kuncman

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引用次数: 0

Abstract

Purpose: The standard treatment for oligometastatic colorectal cancer includes systemic therapy, with surgery and metastasis-directed therapy as options. The optimal strategy, especially for repeat oligoprogression (rOP), remains unclear. We report outcomes of liver computer tomography-guided high-dose rate brachytherapy (CT-BRT) in this setting.

Methods: This retrospective cohort study included colorectal cancer patients with liver-only oligoprogression during systemic therapy, meeting criteria of up to 5 liver metastases, CT-BRT eligibility, and ECOG status ≤ 2. Patients were followed for local response, progression-free survival (PFS), overall survival (OS), and toxicity. Response, according to RECIST 1.1, was initiated 6 months post-CT-BRT.

Results: A total of 262 metastases were treated in 127 patients, with 67.7% receiving third-line or later systemic therapies. One to four liver metastases were found in 29.1%, 42.5%, 21.2%, and 7.1% of patients, respectively, with a median volume of 128 cm³. A median of 3 applicators was used, with CT-BRT doses of 15 Gy, 20 Gy, and 25 Gy given to 29.9%, 41.7%, and 28.3% of patients. At 6 months complete response occurred in 3.1%, progressive disease in 23.6%, partial response in 19.7%, and stable disease in 53.5%. Median PFS was 9 months, median OS was 16 months, with 1-year and 2-year OS rates of 65% and 16%, respectively. Liver-only metastases and objective response were associated with longer PFS. The G3 toxicity was 4.0%; no events > G3 were reported.

Conclusions: This largest study documents favorable outcomes of liver CT-BRT for rOP, establishing this method as a viable option in this indication.

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综合队列研究：计算机断层扫描引导下的高剂量率近距离放疗作为转移导向治疗重复少进展的结直肠癌肝转移。

目的：低转移性结直肠癌的标准治疗包括全身治疗，手术和转移导向治疗作为选择。最佳策略，特别是重复寡进展（rOP），仍不清楚。我们报道在这种情况下，肝脏计算机断层扫描引导的高剂量率近距离放射治疗（CT-BRT）的结果。方法：本回顾性队列研究纳入了在全身治疗期间仅肝脏少进展的结直肠癌患者，符合多达5个肝转移的标准，符合CT-BRT资格，ECOG状态≤2。随访患者局部反应、无进展生存期（PFS）、总生存期（OS）和毒性。根据RECIST 1.1，响应在ct - brt后6个月开始。结果：127例患者共治疗262例转移瘤，67.7%接受了三线或之后的全身治疗。29.1%、42.5%、21.2%和7.1%的患者发现1 ~ 4个肝转移灶，中位体积128 cm3。使用中位数为3个涂抹器，29.9%，41.7%和28.3%的患者使用15 Gy， 20 Gy和25 Gy的CT-BRT剂量。6个月时，完全缓解的发生率为3.1%，进展性疾病的发生率为23.6%，部分缓解的发生率为19.7%，病情稳定的发生率为53.5%。中位PFS为9个月，中位OS为16个月，1年和2年OS率分别为65%和16%。仅肝转移和客观反应与更长的PFS相关。G3毒性为4.0%；无> G3事件报告。结论：这项规模最大的研究证明了肝脏CT-BRT治疗rOP的良好结果，确立了该方法作为该适应症的可行选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiologia Medica 医学-核医学

CiteScore

14.10

自引率

7.90%

发文量

133

审稿时长

4-8 weeks

期刊介绍： Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.